Clinical Champion Spotlight
This series highlights members of the GEDC community who are clinical champions for older adults in the emergency department. Dr. Teresita Hogan is a Professor of Medicine and Director of Geriatric Emergency Medicine at the University of Chicago Medicine. Her clinical research interests are Geriatric EM, Quality Improvement, Emergency Pain Management, and Emergency Management of Falls in Older Adults.
Dr. Hogan is the American College of Emergency Physicians (ACEP) representative to the American Geriatrics Society (AGS), and serves on the executive committee Section for Enhancing Geriatric Understanding and Expertise among Surgical and Medical Specialists. She is an expert in graduate medical education and led the expert consensus process to establish The Geriatric Competencies for Emergency Medicine Residents. She also worked on identifying the number and characteristics of geriatric emergency departments (GEDs), across the United States and is a member of the GED Accreditation Board of Governors.
Dr. Teresita Hogan’s interest in geriatric emergency medicine began when her residency director invited her to be part of the Society for Academic Emergency Medicine’s Geriatric Task Force. What she experienced as a member of this group shaped the course of her career in geriatric emergency medicine.
“The welcome and support from this group was formative,” Hogan said. “They had a joyful sense of mission unrivaled anywhere in medicine. I was hooked by their enthusiasm and passion. I understood the need to reform emergency medicine’s treatment of older patients. I witnessed impressive advances as the group collectively attacked the problem.”
Hogan’s desire to work in graduate medical education was prompted when she began directing residents through her emergency department at St. Francis Hospital in Evanston, Illinois. She then transitioned to Chicago’s Resurrection Medical Center, where she started their Emergency Medicine Residency Program, developing their RRC application, clinical rotations, faculty and didactic curriculum. During this time, Hogan completed the Brookdale Leadership in Aging Fellowship, which solidified her passion for pursuing better healthcare for older adults that continues to this day.
Hogan is now a GEDC Core Faculty Member and specializes in research in geriatric emergency medicine. Her current research focuses on pain in older adults, and for the past three years, she has studied the role of Fascia Iliaca Compartment Blocks in routine emergency department care of hip fractures.
“This block is not just a research endeavor but an evidence-based best practice that should be used in every ED daily to relieve pain effectively with minimal reliance on opioids,” Hogan said. “I am inspired by the faces of my patients. When a person with a hip fracture gets a hip block in a few minutes they change from crying in pain to asking for a sandwich, this is compelling.”
Throughout her research process, Hogan learned that patients with dementia received poor pain assessments and inferior pain treatment due to their limited communication availability. To address this issue, she has received a pilot grant from the National Institute on Aging to promote the use of the PAIN-Advanced Dementia Scale among busy emergency department clinicians. Known as the PAINAD scale, this tool is a helpful assessment for patients with advanced dementia who are unable to provide a numeric pain score.
The grant will provide education and a computer decision support tool containing the PAINAD scale to emergency department nurses in two healthcare systems – the University of Chicago and the University of North Carolina –when they are working with patients who have a preexisting diagnosis of advanced dementia and present to the emergency department with hip pain.
Nurses will be presented with the computer decision support screen containing the scale during their intake assessment and one hour after the first analgesic medication is administered to their patient. The goal is to increase PAINAD assessment and measure its effect on analgesic administration and relief of pain intensity.
In addition to this research, Hogan is currently assisting with updates to the official GED guidelines for caring for patients with dementia.
She has also recently published an article in the Journal of Geriatric Emergency Medicine titled, “The History of Geriatric Emergency Medicine.” The article chronicles the progress of geriatricians, emergency physicians and philanthropists who joined forces to improve patient care for older adults in the early 1990s.
“We grew from not understanding why ED care failed older patients to establishing a new subspecialty of GEM,” Hogan said. “Now we must strategically consider if and when we want to formalize this designation. It has implications for funding and graduate medical education/fellowships that must be considered.
“Today millions of older patients receive GED level care. They benefit daily from the many initiatives targeted to improve their ED assessment, treatment, and disposition. GEM is radically improving the way we treat older patients.”
Dr. Teresita Hogan is a Professor of Medicine and Director of Geriatric Emergency Medicine at the University of Chicago Medicine. Her clinical research interest are Geriatric EM, Quality Improvement, Emergency Pain Management, Emergency Management of Falls in Older Adults, and Models of Care. Dr. Hogan is the ACEP representative to the AGS and serves on the executive committee Section for Enhancing Geriatric Understanding and Expertise among Surgical and Medical Specialists. She is an expert in graduate medical education and led the expert consensus process to establish The Geriatric Competencies for Emergency Medicine Residents.
She has also worked on identifying the number and characteristics of geriatric emergency departments across the United States and is a member of the GEDA Board of Governors.